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Echinococcosis
BASIC INFORMATION
DEFINITION
EPIDEMIOLOGY
SPECIES, AGE, SEX
RISK FACTORS
Exposure and ingestion of intermediate hosts (rodents, cattle, sheep) harboring the hydatid cysts
CONTAGION & ZOONOSIS
CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
ETIOLOGY AND PATHOPHYSIOLOGY
DIAGNOSIS
DIAGNOSTIC OVERVIEW
The main concern is zoonosis: this is an extremely pathogenic zoonotic parasite, so great care should be taken when handling any feces from a dog suspected of harboring adult E. granulosus. The diagnosis is confirmed in tissue (histopathologic analysis of a biopsy or necropsy specimen) or PCR.
DIFFERENTIAL DIAGNOSIS
Other taeniids, to include many tapeworms within the genera Taenia and Multiceps.
INITIAL DATABASE
Fecal examination may reveal eggs which are identical to other taeniids. Among the three genera (Echinococcus, Taenia, and Multiceps), the eggs of the taeniids are very similar in their structure. Each egg has a centralized portion that demonstrates 6 tiny hooklets. This central portion is surrounded by a striated egg shell that surrounds the egg. Latex gloves should be worn when handling suspect feces, and strict observance of lab biosafety is essential. All materials related to the fecal flotation procedure should be autoclaved prior to disposal. Feces should be disposed of with similar caution.
TREATMENT
TREATMENT OVERVIEW
Due to the zoonotic nature of this parasite, appropriate anthelminthic therapy treatment is critical for eliminating the adult cestode.
TREATMENT
PEARLS & CONSIDERATIONS
COMMENTS
Echinococcosis does not cause hydatid cyst disease in definitive hosts such as dogs and cats. Therefore, its interest in small-animal medicine mainly revolves around the risk of zoonosis.
PREVENTION
TECHNICIAN TIPS
Think safety—use extreme caution! Due to the extreme pathogenicity of this parasite, all suspect feces should be collected and properly disposed. One cannot simply throw this feces away refuse or wash it down the drain; it should be incinerated.
Eckert J, Thompson RC, Bucklar H, Bilger B, Deplazes P. Efficacy evaluation of epsiprantel (Cestex) against Echinococcus multilocularis in dogs and cats. Berl Munc Tierarztl Wochenchr. 2001;114(3–4):121-126.
Jenkins DJ, Romig T. Milbemycin oxime in a new formulation, combined with praziquantel, does not reduce the efficacy of praziquantel against E. multilocularis in cats. J Helminthol. 2003;77(4):367-370.
Eclampsia
BASIC INFORMATION 
DEFINITION
Moderate to severe hypocalcemia of the lactating female, most often occurring in the first four weeks postpartum.
EPIDEMIOLOGY
GENETICS & BREED PREDISPOSITION
More likely to occur in small-breed dogs, although any lactating bitch may be affected
CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
Lactating bitch with signs of aberrant behavior, ataxia, muscle tremors, seizures, and/or tetany
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
A presumptive diagnosis (based on history, clinical signs, and physical exam) warrants immediate treatment. Response to therapy is the most reliable diagnostic aid.
TREATMENT 
TREATMENT OVERVIEW
Treatment is primarily aimed at alleviating clinical signs of hypocalcemia via parenteral calcium therapy while monitoring for bradycardia and/or arrhythmias. Secondary hypoglycemia and hyperthermia must also be addressed in the seizuring animal.
ACUTE GENERAL TREATMENT
CHRONIC TREATMENT
NUTRITION/DIET
BEHAVIOR/EXERCISE
If puppies are weaned to stop lactation, monitor dam for self-milking (licking own mammary glands, which can induce milk letdown).
POSSIBLE COMPLICATIONS
Overly rapid or unmonitored IV calcium administration can lead to severe bradycardia, ventricular arrhythmias, hypotension, and death.
PROGNOSIS AND OUTCOME 
Prognosis is good to excellent with immediate treatment and subsequent management.
PEARLS & CONSIDERATIONS 
COMMENTS
TECHNICIAN TIPS
Knowing the signs of hypocalcemia (Physical Exam, above) helps technicians quickly identify a patient in need of calcium.
Edema, Subcutaneous
BASIC INFORMATION 
DEFINITION
Subcutaneous edema is the local or generalized observable swelling from excessive fluid accumulation within the interstitial tissue spaces under the skin. Under normal circumstances, only a small amount of fluid leaks from vessels to form interstitial fluid, which is then removed by lymphatic vessels.
SYNONYMS
Peripheral edema (edema of the paws and legs), anasarca (generalized, massive subcutaneous edema)
CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
Limb swelling or a swollen appearance may be historical findings suggestive of subcutaneous edema.
PHYSICAL EXAM FINDINGS
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
Subcutaneous edema can be identified on physical exam (readily if it is very pronounced but less easily if it is mild in degree). The presence of subcutaneous edema warrants assessing the serum albumin concentration and also ruling out heart disease (thoracic radiographs, echocardiogram).
DIFFERENTIAL DIAGNOSIS
When edema affects only one leg, local factors such as neoplasia, trauma, or phlebitis should be considered. Swollen extremities and ventral edema are uncommonly seen with congestive heart failure. In the rare instance (in small animals) where subcutaneous edema is present secondary to congestive heart failure, the edema is usually symmetric in distribution.
TREATMENT 
ACUTE AND CHRONIC TREATMENT
PROGNOSIS AND OUTCOME 
The prognosis for patients with subcutaneous edema depends on the underlying condition and the ability to treat and resolve this primary disease. Edema due to inflammation or infection, congestive heart failure, or hypoproteinemia can often be successfully managed or resolved. Treatment response for lymphatic obstruction is variable; lymph-edema (see p. 667) can be challenging to manage long term, and there is no curative therapy.
Mathews KA. Monitoring fluid therapy and complications of fluid therapy. In: Dibartola SP, editor. Fluid, electrolyte, and acid-base disorders in small animal practice. ed 3. St Louis: Elsevier Saunders; 2006:385.
Raffe MR, Roberts J. Edema. In: Ettinger SJ, Feldman EC, editors. Veterinary internal medicine. ed 6. St Louis: Elsevier Saunders; 2005:70.
Ehrlichiosis, Canine Monocytic
BASIC INFORMATION 
DEFINITION
Tick-transmitted disease caused by Ehrlichia canis or Ehrlichia chaffeensis infection. These organisms predominantly infect circulating monocytes, macrophages, and lymphocytes, causing nonspecific signs (fever, anorexia, lethargy, inappetence), bleeding, anemia, and cytopenias. Chronically, E. canis infection can cause bone marrow suppression, pancytopenia, glomerulonephritis, and death.
SYNONYMS
Canine monocytotropic ehrlichiosis (E. canis), human monocytic ehrlichiosis (E. chaffeensis), tropical pancytopenia
EPIDEMIOLOGY
GENETICS & BREED PREDISPOSITION
German shepherd dogs have a more fulminant illness, owing to reduced cellular immune response.
RISK FACTORS
E. canis is transmitted by Rhipicephalus sanguineus (brown dog tick), whereas E. chaffeensis is transmitted by Amblyomma americanum (lone star tick) or Dermacentor variabilis (American dog tick). R. sanguineus is an urban tick capable of completing its entire life cycle indoors (exposure risk when boarding, pet stores, etc.) Therefore, access to wooded areas, outdoor activities, and tick season are risk factors for E. chaffeensis infection but not for E. canis infection.
CONTAGION & ZOONOSIS
Most Ehrlichia spp. may be infectious to humans, but there is no direct dog-to-dog or dog-to-human transmission. Personal protective equipment (gloves and safety glasses) should be used when handling biological samples (inoculation risk).
GEOGRAPHY AND SEASONALITY
E. canis infection has been found in most tropical and subtropical regions in the world, based on distribution of the vector. Because of different disease forms (acute, subacute, and chronic), there is no true seasonality. E. chaffeensis has been described predominantly in the United States, with emergence in South Korea, southern China, and Cameroon.
CLINICAL PRESENTATION
DISEASE FORMS/SUBTYPES
HISTORY, CHIEF COMPLAINT
PHYSICAL EXAM FINDINGS
ETIOLOGY AND PATHOPHYSIOLOGY
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
The diagnosis is suspected based on the presence of anorexia, fever, lethargy, and/or bleeding tendencies in a dog with tick exposure, hematologic and clinical chemistry abnormalities, and response to therapy. Presumptive diagnosis is often based on specific antibody detection. Definitive diagnosis depends upon visualization of the organisms, microbial DNA amplification and genetic sequencing, or a fourfold change in antibody titers between acute and convalescent samples, but treatment often is indicated in patients showing overt clinical signs of ehrlichiosis before such results are available.
INITIAL DATABASE
ADVANCED OR CONFIRMATORY TESTING
TREATMENT 
TREATMENT OVERVIEW
ACUTE GENERAL TREATMENT
CHRONIC TREATMENT
Chronic infections can occur with E. canis; however, response to doxycycline after 28 days of treatment is expected.
DRUG INTERACTIONS
PROGNOSIS AND OUTCOME 
PEARLS & CONSIDERATIONS 
COMMENTS
Eisenmenger’s Syndrome
BASIC INFORMATION
DEFINITION
Uncommon syndrome involving any large communication between the left and right sides of the heart, in association with severe pulmonary hypertension, which results in right-to-left shunting of blood.
SYNONYMS
EPIDEMIOLOGY
GENETICS & BREED PREDISPOSITION
Dependent on the underlying cause:
ETIOLOGY AND PATHOPHYSIOLOGY
DIAGNOSIS
DIAGNOSTIC OVERVIEW
The diagnosis is suspected in a young patient presenting with dyspnea, cyanosis, and collapsing episodes. Polycythemia and right heart enlargement are usually present. An echocardiogram with contrast is required for confirmation.
INITIAL DATABASE
TREATMENT
TREATMENT OVERVIEW
Initial control of polycythemia and signs of hyperviscosity can be achieved with periodic phlebotomies. Hydroxyurea and a phosphodiesterase-V inhibitor (to reduce severity of pulmonary hypertension) may be started if clinical signs persist. Consider referral to cardiologist for diagnosis and advice on treatment plan.
ACUTE GENERAL TREATMENT
CHRONIC TREATMENT
BEHAVIOR/EXERCISE
Restrict exercise and excitement in patients with collapsing or syncopal episodes.
DRUG INTERACTIONS
Hydroxyurea: reversible bone marrow suppression (pancytopenia), anorexia, vomiting and diarrhea, sloughing of nails are possible.
PROGNOSIS AND OUTCOME
Long-term prognosis is guarded to poor, depending on severity of pulmonary hypertension.

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